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<br />81 :3-780-0020
<br />
<br />Fax-813-780-0021
<br />
<br />
<br />Date Received
<br />
<br />Owner Phone Number
<br />
<br />Owner Phone Number I
<br />
<br />Owner Phone Number I
<br />
<br />Owner's Name
<br />
<br />I
<br />I
<br />I
<br />:5JOI 1M-5I-.) ~,fb, J::L 33/:;4:J... I LO" Ir?7? I
<br />PARCELlD#1 /I-;l.~- :J.J--!J6/6-- J'ff'-f00--6tJ 40 I
<br />(OBTAINED FROM PROPERTY TAX NOTICE)
<br />SIGN 0 MOVE D
<br />
<br />Fee Simple Titleholder Address 1
<br />
<br />~me
<br />
<br />JOB ADDRESS
<br />
<br />SUBDIVISION
<br />
<br />PROPOSED USE
<br />TYPE OF CONSTRUCTION
<br />
<br />B
<br />D
<br />D
<br />
<br />NEW CONSTR
<br />INSTALL
<br />SFR
<br />BLOCK
<br />
<br />
<br />D
<br />D
<br />D
<br />On UJ l ~C1L..
<br />/0310 n
<br />
<br />ADD/ALT
<br />REPAIR
<br />COMM
<br />FRAME
<br />
<br />DEMOLISH
<br />
<br />WORK PROPOSED
<br />
<br />OTHER I
<br />STEEL 0
<br />
<br />OTHER I
<br />
<br />DESCRIPTION OF WORK
<br />
<br />
<br />n5
<br />
<br />D
<br />
<br />o()~
<br />I,/)l ,/ C 2 \ I
<br />BUILDING SIZE ~ c^ !. oJ, L
<br />.
<br />
<br />
<br />1$55.:%O~ I
<br />
<br />-'
<br />
<br />1$ I
<br />1$ I
<br />1$ I
<br />D GAS D ROOFING D
<br />FINISHED FLOOR ELEVATIONS 1 I
<br />
<br />BUILDING
<br />
<br />VALUATION OF TOTAL CONSTRUCTION
<br />
<br />ELECTRICAL
<br />
<br />AMP SERVICE
<br />
<br />~
<br />
<br />PROGRESS ENERGY
<br />
<br />D
<br />
<br />W.R.E,C,
<br />
<br />D
<br />D
<br />D
<br />
<br />MECHANICAL
<br />
<br />VALUATION OF MECHANICAL INSTALLATION
<br />
<br />;1JtL/
<br />
<br />PLUMBING
<br />
<br />SPECIALTY D
<br />FLOOD ZONE AREA
<br />
<br />OTHER
<br />DYES
<br />
<br />~O
<br />
<br />Address
<br />
<br />
<br />i~~?~cIJ:L~/~~~C
<br />
<br />License # I (LfU!.. CJ!::J-? 5/7
<br />
<br />I ~~ fi~ct;G 1t'~/N
<br />
<br />
<br />License # I
<br />
<br />I
<br />I
<br />I
<br />I
<br />RJ{z; - J0JLLkr I
<br />I[i) N I FEE CURRENT IC:D N I
<br />
<br />License # I ~C-/Lf;L671? I
<br />
<br />
<br />BUILDER
<br />SIGNATURE
<br />
<br />Address
<br />
<br />ELECTRICIAN
<br />SIGNATURE
<br />
<br />PLUMBER
<br />SIGNATURE
<br />
<br />Address
<br />
<br />MECHANICAL
<br />SIGNATURE
<br />
<br />Address
<br />
<br />License #
<br />
<br />OTHER
<br />SIGNATURE
<br />
<br />COMPANY
<br />REGISTERED
<br />
<br />FEE CURRENT
<br />
<br />Address License #
<br />111111111111111111111111111I1111111111111111I11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
<br />RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction,
<br />Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects
<br />COMMERCIAL Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction.
<br />Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence installed,
<br />Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects, All commercial requirements must meet compliance
<br />SIGN PERMIT Attach (2) sets of Engineered Plans,
<br />.".PROPERTY SURVEY required for all NEW construction,
<br />
<br />DI~~~i:i~~~': . . . , . , . . , , , . . , , . . , . . . . . . . . . . , , , . . . . , , . . . . . . . , , . . . , , . . . . , . . . . . , , , . . . . . , , , . . , , , . . , , , . . . . , , , . . . . . . , . , , , , . . . . . , . . , , , , . , . . , , . , , . , , , , , , , , , , , ,
<br />
<br />Fill out application completely.
<br />Owner & Contractor sign back of application. notarized
<br />If over $2500. a Notice of Commencement Is required. (AlC upgrades over $5000)
<br />
<br />Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
<br />
<br />OVER THE COUNTER PERMITTING (Front of Application Only)
<br />Reroofs Sewers Service Upgrades NC Fences (PloUSurvey/Footage)
<br />
<br />Driveways-Not over Counter if on public roadways..needs ROW
<br />
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